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A Pilot Study using the Compensatory Reserve Index to evaluate individuals with Postural Orthostatic Tachycardia syndrome

Published online by Cambridge University Press:  30 September 2020

Niti Shahi Open the ORCID record for Niti Shahi [Opens in a new window] ,
Gabrielle Shirek ,
Kaci Pickett ,
Alexandra Schwartz ,
Jamie Shoop ,
Ryan Phillips ,
Rachel Workman ,
David Kaplan ,
Clio Pitula  and
Steven Moulton
Niti Shahi*
Affiliation:
Division of Paediatric Surgery, Children’s Hospital Colorado, Aurora, CO, USA Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA Department of Surgery, University of Massachusetts, Worcester, MA, USA
Gabrielle Shirek
Affiliation:
Division of Paediatric Surgery, Children’s Hospital Colorado, Aurora, CO, USA
Kaci Pickett
Affiliation:
The Center for Research in Outcomes for Children’s Surgery, University of Colorado School of Medicine, Aurora, CO, USA
Alexandra Schwartz
Affiliation:
Analytics Resource Center, Children’s Hospital Colorado, Aurora, CO, USA
Jamie Shoop
Affiliation:
UPMC Children’s Hospital of Pittsburgh, Transplant Surgery, Pittsburgh, PA, USA
Ryan Phillips
Affiliation:
Division of Paediatric Surgery, Children’s Hospital Colorado, Aurora, CO, USA Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA
Rachel Workman
Affiliation:
Department of Paediatrics, University of Colorado School of Medicine, Aurora, Co, USA
David Kaplan
Affiliation:
Department of Paediatrics, University of Colorado School of Medicine, Aurora, Co, USA
Clio Pitula
Affiliation:
Department of Paediatrics, University of Colorado School of Medicine, Aurora, Co, USA
Steven Moulton
Affiliation:
Division of Paediatric Surgery, Children’s Hospital Colorado, Aurora, CO, USA Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA
*
Author for correspondence: Niti Shahi, MD, Department of Surgery, University of Massachusetts School of Medicine, 55 Lake Avenue North, Worcester, MA01655, USA. Fax: (844)-804-3061. E-mail: [email protected]
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Abstract

Purpose:

The diagnosis of Postural Orthostatic Tachycardia syndrome traditionally involves orthostatic vitals evaluation. The Compensatory Reserve Index is a non-invasive, FDA-cleared algorithm that analyses photoplethysmogram waveforms in real time to trend subtle waveform features associated with varying degrees of central volume loss, from normovolemia to decompensation. We hypothesised that patients who met physiologic criteria for Postural Orthostatic Tachycardia syndrome would have greater changes in Compensatory Reserve Index with orthostatic vitals.

Methods:

Orthostatic vitals and Compensatory Reserve Index values were assessed in individuals previously diagnosed with Postural Orthostatic Tachycardia syndrome and healthy controls aged 12–21 years. Adolescents were grouped for comparison based on whether they met heart rate criteria for Postural Orthostatic Tachycardia syndrome (physiologic Postural Orthostatic Tachycardia syndrome).

Results:

Sixty-one patients were included. Eighteen percent of patients with an existing Postural Orthostatic Tachycardia syndrome diagnosis met heart rate criteria, and these patients had significantly greater supine to standing change in Compensatory Reserve Index (0.67 vs. 0.51; p<0.001). The optimal change in Compensatory Reserve Index for physiologic Postural Orthostatic Tachycardia syndrome was 0.60. Patients with physiologic Postural Orthostatic Tachycardia syndrome were more likely to report previous diagnoses of anxiety or depression (p = 0.054, 0.042).

Conclusion:

An accurate diagnosis of Postural Orthostatic Tachycardia syndrome may be confounded by related comorbidities. Only 18% (8/44) of previously diagnosed Postural Orthostatic Tachycardia syndrome patients met heart rate criteria. Findings support the utility of objective physiologic measures, such as the Compensatory Reserve Index, to more accurately identify patients with true autonomic dysfunction.

Keywords

DysautonomiaPostural Orthostatic Tachycardia syndromeadolescentCompensatory Reserve Indexheart rate
Type
Original Article
Information
Cardiology in the Young , Volume 30 , Issue 12 , December 2020 , pp. 1833 - 1839
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Copyright
© The Author(s), 2020. Published by Cambridge University Press

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Footnotes

*

Co-senior authors

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